Join me as I half-ass my way through medical school, encountering all sorts of freaks (patients, classmates, myself, etc.) along the way

Friday, February 04, 2005

My Preceptor & Me

Upon entering medical school, many people offered advice.The money is in dermatology.Try your best to stop your incompetence from getting in the way of not killing people.Keep on being the devilishly perfect handsome future doctor that Jewish mothers around the world hope will marry one of their daughters.But the most resounding piece of advice I’ve received thus far has been something along the lines of: find a mentor.

While I’ve only been in medical school for about a year and a half now, I can say that I have been exposed to doctors from just about every specialty and every walk of life.There’s the self-important stickuptheirass surgeons.The vacuums devoid of personality otherwise known as nephrologists.The completely psychotic psychiatrists.The neurotic and insecure pediatricians (pediatrics it is!).Often lost among this crowd of physician specialists are the family medicine doctors.These primary care “specialists” are often degraded by their colleagues and looked down upon as inferior, which is ironic given that these doctors are most likely to first see a patient who is actually ill and be most likely to help the patient over the course of the patient’s lifetime.Whatever the case may be, the wise folks at my medical school insist that by pairing each of us with a family medicine practitioner in the community (our so-called “preceptor”) and learning from them during our first two years, we would no doubt pick up general skills that will help us throughout the rest of our training.Some people got paired up with doctors who treat rich people and did not let the students do hands on stuff or really learn much of anything because, lets face it, rich people just don’t put up with morons like us.Some people got paired up with doctors who see 60+ patients per day in order to make ends meet and can’t spend more than 10 minutes with a patient, thus leaving no time for teaching.

Then there’s my guy.From day one, he threw me in the fire and had me touching swollen penises (calm down, I don’t play for that team) and giving cortisone injections by marking an X on some poor schmuck’s shoulder and handing me a needle when I didn’t have the slightest clue what I was doing.However, it wasn’t until today that I realized how lucky I was to be paired up with this guy.

First, I should say that he knows his shit.Like he seriously knows his shit.But the thing is, there are a whole lot of doctors who know their shit cold, so that alone isn’t what impresses me.(By the way, by “shit” I mean the voluminous body of clinical knowledge needed to effectively practice medicine.But you knew that.)No.The thing that catches my eye the most is his ability to completely and utterly mess with his patients and the medical establishment, and not only get away with it, but come out on top of it all.

What the hell is this fool talking about, you ask? (Which of course is better than, Why am I still reading this crap?)Well, let me give you an excerpt from a patient interaction from today.We were talking with an elderly patient who had recently undergone a valvular replacement surgery.Among his problems upon followup, he was experiencing a loss of appetite, and his family members in attendance were very concerned about this.Now, a big loss of weight and appetite after a monstrous operation is pretty common, and there’s really not anything the doctor could do other than give the patient this liquid crap that the patient had already been trying and doesn’t really work anyways.The doctor could have just said nothing could be done.Or, the doctor could have done what they’ve been trying to teach us in our doctoring course where we are learning how to talk to patients:bore the patient to death with counseling and delve into the utter minutiae of the patient’s lifestyle in order to make stupid suggestions on how to change eating habits that the patient will under no circumstances actually do anyways.Instead, the doctor followed with this statement:

“Well, maybe he could go roll up a joint and smoke out.That’ll give him the munchies.”

My jaw almost dropped, but the patient’s family members just laughed and understood the implication that there was nothing that the doctor could do.Worked like a charm.

And what of the medical establishment?Something that is valued among doctors today is doing research and/or getting published.But let’s say you don’t really want to do intense research?Well, my preceptor and I were chatting in his office and he mentioned he just got a review article published in the premier journal for his specialty.I was of course impressed.After all, any journal publication undoubtedly involves many hours of work, including doing intense literature searches, making concise and informative tables and graphs, and writing clear and concise articles.He had me get closer to his computer to show him his paper on the computer, and then pointed to the graphs and laughed:

“Hey check this out.See these graphs?I was just dicking around on that stupid graph thing on Microsoft Word and made these half-assed pictures.And they published them!”

Perhaps you cannot appreciate the comedy of that situation, but for those of you who have ever tried to do research and have tried to get something published, you might understand how ridiculous that statement was.

Anyways, I don’t think I want to be a family medicine doctor.But I have already learned so much from my preceptor about doctor-patient interaction, and I know I have only just cracked the surface.Now go smoke some weed damn it!